title: A randomized controlled trial of two nasal continuous positive airway pressure levels after extubation in preterm infants.
abstract: OBJECTIVE
  To compare extubation failure rate with two ranges of nasal continuous positive airway pressure (NCPAP) in oxygen dependent preterm infants.
  
  
  METHODS
  Preterm infants of birth weight 500-1000 g and gestational age 23-30 weeks, extubated for the first time during the first 6 weeks while requiring fraction of inspired oxygen ≥ 0.25, were randomly assigned to a NCPAP range of 4-6 (low NCPAP) or 7-9 (high NCPAP) cmH2O.
  
  
  RESULTS
  Infants were randomized to low (n = 47) or high NCPAP (n = 46) at day 16.3 ± 14.7 and 15.5 ± 12.4, respectively. Rates of extubation failure per criteria (24% vs 43%, P = .04, OR and 95% CI: 0.39 [0.16-0.96]) and re-intubation (17% vs 38%, P = .023, 0.33 [0.016-0.85]) within 96 hours were significantly lower in the high- compared with the low NCPAP group. This was mainly due to a strikingly lower failure rate in the 500-750 g birth weight strata. Duration of ventilation, bronchopulmonary dysplasia, or severe bronchopulmonary dysplasia did not differ significantly. No infant developed pneumothorax during 96 hours post-extubation.
  
  
  CONCLUSIONS
  Extubation failure in preterm infants with residual lung disease was lower with NCPAP range of 7-9 compared with 4-6 cmH2O. These findings suggest the need for higher distending pressure post-extubation in the more immature infants who are still oxygen dependent.
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL.
authors.forename: Bridget
authors.initials: B
authors.lastname: Buzzella
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL. Electronic address: nclaure@miami.edu.
authors.forename: Nelson
authors.initials: N
authors.lastname: Claure
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL.
authors.forename: Carmen
authors.initials: C
authors.lastname: D'Ugard
authors.affiliation: Division of Neonatology, Department of Pediatrics, University of Miami Miller School of Medicine/Jackson Memorial Hospital, Miami, FL.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bancalari
mesh_terms: D060666:Airway Extubation; D045422:Continuous Positive Airway Pressure / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D009666:Nose; D012127:Respiratory Distress Syndrome, Newborn / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D015300:Ventilator Weaning
keywords: BPD; BW; Birth weight; Bronchopulmonary dysplasia; FiO(2); Fraction of inspired oxygen; GA; Gestational age; NCPAP; NICU; Nasal continuous positive airway pressure; Neonatal intensive care unit; PDA; PMA; Patent ductus arteriosus; Post-menstrual age